Balanoposthitis

Balanoposthitis vs balanitis and posthitis

• Balanitis: inflammation of the glans only. It can occur in circumcised men.
• Posthitis: inflammation of the foreskin only.
• Balanoposthitis: both together, the usual pattern in uncircumcised males, because the warm, moist space under the foreskin affects both surfaces.

Symptoms

• Redness and swelling of the glans and foreskin
• Soreness, itching or burning
• A thick, white or yellow discharge under the foreskin, sometimes with an unpleasant smell
• Pain when passing urine
• Pain or difficulty pulling back the foreskin
• Shiny or patchy red areas, small spots or cracks in the skin
• In children, crying while urinating or the foreskin ballooning

Causes

Infections

• Candida (yeast): the most common infectious cause in adults; red patches with small spots and white discharge, often itchy. Linked to diabetes, antibiotics and a partner with a vaginal yeast infection.
• Bacteria: streptococci, staphylococci and anaerobic bacteria, sometimes with a foul smell.
• Sexually transmitted infections: trichomonas, gonorrhea, herpes and syphilis can cause or mimic it.

Non-infectious causes

• Poor hygiene, with buildup of smegma (natural secretions) under the foreskin
• Over-washing or using soaps, shower gels, bubble baths and antiseptics, which irritate delicate skin
• Allergy or irritation from latex condoms, lubricants or spermicides
• Tight foreskin (phimosis), which makes cleaning difficult
• Skin conditions: eczema, psoriasis, lichen planus and lichen sclerosus
• Reactive arthritis, which can cause circinate balanitis
• Fixed drug eruptions from medicines

Risk factors

• Being uncircumcised
• Diabetes, particularly when poorly controlled, because sugar in the urine feeds yeast
• Recent antibiotics
• Obesity
• Weakened immune system
• In young boys, forcible retraction of the foreskin or poor drying after bathing

Diagnosis

A doctor diagnoses balanoposthitis by examining the penis and asking about hygiene, products, sexual history and symptoms. They may:

• take a swab to identify yeast or bacteria
• test for sexually transmitted infections
• check urine or blood sugar for diabetes
• arrange a biopsy if the problem keeps recurring, does not respond to treatment, or there are white or scarred patches, to exclude lichen sclerosus or rarely penile cancer

Treatment

General measures

• Wash the penis once a day with warm water, gently pulling back the foreskin (only as far as it goes comfortably in adults; never force it in children).
• Use a soap substitute such as an emollient instead of soap.
• Dry gently but thoroughly before replacing the foreskin.
• Avoid perfumed products, antiseptics and tight underwear.
• A saltwater soak (a teaspoon of salt in a pint of warm water) can ease soreness.

Medicines

• Antifungal cream such as clotrimazole for yeast infection, usually for 1 to 2 weeks.
• Antibiotic cream or tablets for bacterial infection.
• Mild steroid cream, sometimes combined with an antifungal, for irritant or allergic inflammation.
• Treatment of sexual partners for yeast or STIs where relevant.
• Better blood sugar control in diabetes.

For recurrent cases

Circumcision is considered for people with repeated balanoposthitis, phimosis or lichen sclerosus that does not respond to other treatment.

Complications

• Phimosis from scarring
• Paraphimosis
• Narrowing of the urethral opening (meatal stenosis)
• Lichen sclerosus
• Chronic inflammation, which slightly increases the risk of penile cancer

Prevention

• Wash daily with water and dry under the foreskin.
• Avoid harsh soaps and irritants.
• Use condoms and get tested for STIs.
• Keep diabetes well controlled.
• In children, do not forcibly retract the foreskin; it naturally becomes retractable over the first years of life, sometimes not until the teens.

Frequently asked questions

What causes balanoposthitis?

The most common causes are a yeast infection, poor hygiene with buildup of secretions under the foreskin, irritation from soaps and other products, and bacterial infection. Diabetes, a tight foreskin, recent antibiotics and certain skin conditions increase the risk.

Is balanoposthitis an STI?

Usually not. Most cases are caused by yeast, bacteria normally present on the skin, or irritation. However, some sexually transmitted infections can cause it, so testing may be advised, and partners may need treatment for yeast infection.

How long does balanoposthitis take to heal?

With proper hygiene and the right cream, most cases improve within a few days and clear within 1 to 2 weeks. If symptoms persist after a week of treatment or keep returning, see a doctor for swabs, a diabetes check and possibly a biopsy.

Can balanoposthitis go away on its own?

Mild cases caused by irritation may settle with gentle washing and stopping irritating products. Infections usually need an antifungal or antibiotic cream. Seeing a doctor helps identify the cause and avoid recurrence.